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Left-sided infective endocarditis (LSIE) bears a high in-hospital mortality rate that has remained unchanged over the past 2 decades [(1)][1]. Our objectives were to investigate whether the clinical profile of patients with LSIE has worsened in this time period and to test the hypothesis that this

The objective was to describe the vegetation changes in patients with endocarditis and evaluate their prognostic importance during hospitalization. We selected patients with left-sided endocarditis and two transesophageal echocardiograms separated by at least 8 days. Patients who required surgery or died during the first week after diagnosis of the disease were excluded. Patients were classified into three groups: I, patients whose vegetation increased in size (n = 34); II, patients with vegetations that did not vary in size (n = 62); and III, patients whose vegetation decreased in size (n = 59). Patients whose vegetation increased in size more frequently required surgery. Multivariate analysis showed that the increase in the vegetation is independently associated with increased mortality: adjusted odds ratio, 4.12 (95% confidence interval, 1.14-14.9; P = .031).

The objective was to describe the vegetation changes in patients with endocarditis and evaluate their prognostic importance during hospitalization. We selected patients with left-sided endocarditis and two transesophageal echocardiograms separated by at least 8 days. Patients who required surgery or died during the first week after diagnosis of the disease were excluded. Patients were classified into three groups: I, patients whose vegetation increased in size (n = 34); II, patients with vegetations that did not vary in size (n = 62); and III, patients whose vegetation decreased in size (n = 59). Patients whose vegetation increased in size more frequently required surgery. Multivariate analysis showed that the increase in the vegetation is independently associated with increased mortality: adjusted odds ratio, 4.12 (95% confidence interval, 1.14-14.9; P = .031).

Whether infection in more than 1 valve worsens the prognosis for endocarditis remains untested. We conducted the current study to determine the profile of multiple-valve endocarditis, compare multiple-valve endocarditis with single-valve endocarditis, and determine predictors of outcome. We conducted a prospective and observational study including 680 episodes of infective endocarditis consecutively diagnosed at 3 tertiary centers. Multiple valve involvement was present in 115 episodes (17%), and single valve involvement in 530 (78%). In the remaining 35 cases, valvular involvement could not be documented. Mean age of patients with multiple valve endocarditis was 58 years. Clinical complications were frequent (heart failure 65%, renal failure 44%, systemic embolisms 24%). The microorganism most frequently isolated was Staphylococcus aureus (22%).Factors predictive of in-hospital mortality in the univariate analysis were septic shock, prosthetic endocarditis, heart failure, and persistent infection. In the multivariate analysis, we detected heart failure (odds ratios [OR], 4.7; 95% confidence interval [CI], 1.6-13.8) and persistent infection (OR, 4.3; 95% CI, 1.7-10.8) as predictors of in-hospital mortality. Compared to single-valve endocarditis, multiple-valve disease was associated more frequently with heart failure (65% vs. 50%, p = 0.03), perivalvular complications (41% vs. 21%, p0.001), and heart surgery (70% vs. 54%, p = 0.002). Despite these differences, in-hospital mortality was similar (28% vs. 30%, p = 0.647). In conclusion, multiple-valve endocarditis has a poor clinical course. Mortality is similar to that of single-valve endocarditis, probably in relation with aggressive therapy including surgery in many patients. Heart failure and persistent infection are independent predictors of death.

Resumen El efecto a largo plazo del trasplante intracoronario de celulas madre de medula osea tras un sindrome coronario agudo con elevacion del ST (SCACEST) es controvertido. Exponemos la evolucion a largo plazo de los parametros relacionados con la funcion ventricular izquierda en 29 pacientes con SCACEST sometidos a esta tecnica. Se realizo resonancia magnetica cardiaca basal, al sexto mes y a largo plazo (27 [24-35] meses). La fraccion de eyeccion del ventriculo izquierdo mejoro significativamente al sexto mes (47,6 ± 8,9% frente a 52,7 ± 11,6%; p = 0,001), mejora que se mantuvo en el seguimiento a largo plazo (52,4 ± 11,8%; p = 0,01 frente a basal, y p = 0,999 frente a sexto mes). No se produjeron cambios significativos en los parametros basales de volumen telediastolico o telesistolico ventricular izquierdo. Nuestro analisis indica que la mejora de la fraccion de eyeccion tras el trasplante celular ocurre tempranamente, dentro de los primeros 6 meses y no se modifica a largo plazo.

Our aims were to investigate the clinical features and prognosis of endocarditis in octogenarian patients (aged >79 years) and in comparison with those in younger elderly patients (aged 65-79 years) and young patients (aged

Our aims were to investigate the clinical features and prognosis of endocarditis in octogenarian patients (aged > 79 years) and in comparison with those in younger elderly patients (aged 65-79 years) and young patients (aged < 65 years). Octogenarian subjects more frequently were male and had a community-acquired infection, mitral valve disease, and chronic anemia. Their clinical course was more insidious and benign: they presented less often with fever or new heart murmurs. When heart failure was present, it tended to be less severe. The most frequently isolated microorganisms were streptococci. The detection rate for vegetation on transesophageal echocardiography was lower in octogenarians. Octogenarians had shorter periods of hospitalization, needed surgery less frequently, and had lower mortality. Mortality in those undergoing surgery was not higher in elderly patients. Age was not an independent predictor of in-hospital mortality.

Background: The existence of different degrees of inflammatory reaction and right ventricular dysfunction after pulmonary resection is well known, though its detection and clinical relevance have not been sufficiently evaluated. The introduction of new biomarkers, particularly brain natriuretic peptide (BNP) and its prohormone (proBNP), together with dynamic imaging techniques such as echocardiography, could prove useful in assessing such response. The aim of this study is to describe the kinetic curve of these biomarkers during uncomplicated pulmonary resection surgery. Furthemore we have studied the right ventricular function by echocardiography in these patients Methods: Demographic data, antecedents and certain perioperative parameters, as well as plasma proBNP, troponin T and C-reactive protein (CRP) levels, were recorded in 38 patients who underwent pneumonectomy (n= 13 ) and lobectomy (n=25), before and 24, 48 and 72 hours after the operation. A transthoracic echocardiogram was carried out preoperatively and 72 hours after surgery. Results: ProBNP showed a significant increase 24 hours after surgery, with a maximum peak after 72 hours (p

Las mujeres presentan diferencias clinicas y pronosticas en muchas enfermedades cardiovasculares e infecciosas respecto a los varones. El objetivo de este trabajo es comparar el perfil de la endocarditis infecciosa izquierda entre varones y mujeres. Se analizo un total de 621 episodios de endocarditis infecciosa izquierda (395 en varones, 226 en mujeres). Se realizo un analisis comparativo de variables epidemiologicas, clinicas, microbiologicas, ecocardiograficas y pronosticas. A pesar de notables diferencias epdemiologicas, ecocardiograficas y microbiologicas entre los dos sexos, las caracteristicas clinicas, la estrategia de tratamiento y el pronostico (mortalidad intrahospitalaria, el 28% en varones y el 35% en mujeres; p = 0,1) fueron similares en nuestra serie.

Introduccion y objetivos La valoracion ecocardiografica de la funcion sistolica ventricular derecha es actualmente una cuestion pendiente de resolver, dadas las peculiaridades anatomicas del ventriculo derecho. Se han desarrollado diversos metodos para su calculo. El objetivo del presente estudio es determinar la fiabilidad y reproducibilidad de diferentes parametros ecocardiograficos estudiando su variabilidad inter e intraobservador. Metodos Se incluyeron 30 pacientes con valvulopatia mitral aislada candidatos a cirugia cardiaca. Se realizo un ecocardiograma a todos los pacientes por dos investigadores de forma independiente en un periodo de 24 h. El analisis intraobservador se obtuvo a partir del primer mes desde imagenes grabadas. Los parametros utilizados fueron la TAPSE (elevacion sistolica del plano del anillo tricuspideo), la velocidad pico sistolica del anillo tricuspideo por Doppler tisular, la fraccion de acortamiento del tracto de salida ventricular derecho, la fraccion de acortamiento de los diametros del ventriculo derecho y la fraccion de acortamiento de las areas del ventriculo derecho. La variabilidad fue analizada mediante el coeficiente de correlacion intraclase. Resultados La fuerza de concordancia de la TAPSE y la velocidad pico del anillo tricuspideo es buena en el analisis interobservador y excelente en el analisis intraobservador. Sin embargo, la fraccion de acortamiento del tracto de salida, de las areas y de los diametros muestran una pobre concordancia en el analisis inter e intraobservador Conclusiones Las medidas ecocardiograficas mas fiables y reproducibles en la valoracion de la funcion sistolica ventricular derecha en pacientes con valvulopatia mitral aislada son la TAPSE y la velocidad pico del anillo tricuspideo.

Background— The influence of age on the main epidemiological, clinical, echocardiographic, microbiological, and prognostic features of patients with infective endocarditis remains unknown. We present the series with the largest numbers and range of ages of subjects to date that analyzes the influence of age on the main characteristics of patients with isolated left-sided infective endocarditis. Furthermore, this series is the first one in which patients have been distributed according to age quartile. Methods and Results— A total of 600 episodes of left-sided endocarditis consecutively diagnosed in 3 tertiary centers were stratified into age-specific quartiles and 107 variables compared between the different groups. With increasing age, the percentage of women, previous heart disease, predisposing disease (diabetes mellitus and cancer), and infection by enterococci and Streptococcus bovis also increased. Valvular insufficiency and perforation and S taphylococcus aureus infection were more common in younger patients. The therapeutic approach differed depending on patient age because of the growing proportion of older patients who only received medical treatment. Clinical course and hospital prognosis were worse in the older patients because of increased surgical mortality among them. Conclusions— Increasing age is associated with less valvular impairment (insufficiency and perforation), a more favorable microbiological profile, and increased surgical mortality among adults with left-sided infective endocarditis.

La utilizacion de la fraccion de eyeccion del ventriculo izquierdo como objetivo subrogado en los ensayos clinicos esta avalada por numerosos estudios. Para que el rendimiento de este objetivo sea aceptable, es esencial ser muy rigurosos en la adquisicion de las imagenes y es conveniente utilizar unidades especificamente dedicadas a analizar cuantitativamente parametros de imagen con las diversas tecnicas disponibles. A continuacion se expone la evidencia disponible en relacion con la fraccion de eyeccion y los volumenes del ventriculo izquierdo, la importancia de las unidades de analisis de imagen y las distintas tecnicas disponibles. Finalmente, se comenta sobre las tecnicas de imagen de eleccion segun el contexto clinico.

Cyclooxygenase (COX)-2 is a central enzyme of arachidonic acid metabolism, and its modulation by statins may explain some of the myocardial protective effects of these drugs. Dendritic cells (DCs) play a central role in microbial defense and in atherogenesis, and COX-2 expression in DCs is important for their migration to lymph nodes and antibody response, thus explaining why prostaglandin E2 is a main component of the cocktails used to prepare DCs for clinical applications. On this basis, we addressed the effect of atorvastatin (ATV) on the release of arachidonic acid and on the expression of COX-2 in human monocyte-derived DCs. Although ATV on its own lacked any effect on COX-2 protein induction expression, it enhanced the release of arachidonic acid, the expression of COX-2 protein, and the production of prostaglandin E2 induced by the fungal wall extract zymosan, and to a lower extent the effect of peptidoglycan. The effect on COX-2 protein was observed mainly 24 h after stimulation by zymosan and was not reverted by mevalonate, thus pointing to an effect unrelated to cholesterol metabolism. It is noteworthy that COX-2 protein showed a great stability, with a t1/2 of approximately 12 h, which was enhanced in the presence of ATV. In view of the important role played by COX-2 on DC function, these data indicate that ATV, by enhancing COX-2 stability, may increase DC function after infectious bouts and also counteract some of the risks associated with sustained inhibition of COX-2. Copyright © 2009 by The American Society for Pharmacology and Experimental Therapeutics., This work was supported by Plan Nacional de Salud y Farmacia [Grant SAF2007-60446]; Red Temática de Investigación Cardiovascular; and Pfizer Inc. [grant-in-aid]. N.F. is under contract within the Ramón y Cajal Program (Ministerio de Educación y Ciencia of Spain and Fondo Social Europeo).

Introduccion y objetivos El sindrome aortico agudo (SAA) tiene una alta mortalidad que obliga a un diagnostico y un tratamiento precoces. El Registro Espanol del Sindrome Aortico Agudo (RESA) pretende valorar los resultados actuales en el manejo del SAA en una amplia cohorte de hospitales terciarios de nuestro pais. Metodos Desde enero de 2005 hasta diciembre de 2007, 24 hospitales terciarios incluyeron a 519 pacientes con SAA (el 78% varones; media de edad, 61 ± 13 [intervalo, 20-92] anos), 357 de tipo A y 162 de tipo B. Resultados El intervalo entre los sintomas y el diagnostico fue 72 h en el 11%. El 80% de los SAA de tipo A fueron tratados quirurgicamente. El intervalo entre el diagnostico y la cirugia fue Conclusiones A pesar de los importantes avances en el diagnostico del SAA, la mortalidad hospitalaria es elevada. Los resultados de este estudio representan una aproximacion mas general y no seleccionada del manejo de esta afeccion y respaldan la necesidad de continuar mejorando la estrategia terapeutica del SAA.

Una medida esencial en la busqueda de la eficiencia hospitalaria es evitar estancias inadecuadas. No se ha publicado ningun estudio en este sentido realizado en un servicio de cardiologia de nuestro pais. Para conocer la tasa de inadecuacion de estancias hospitalarias, hemos realizado un estudio observacional analitico retrospectivo. La recogida de datos se realizo conforme al Appropriateness Evaluation Protocol (AEP). La tasa de inadecuacion fue de 27 estancias cada 100 pacientes-dia. En el analisis multivariable, los factores relacionados con estancias inadecuadas fueron los grupos de mayor edad, las estancias mayores de 7 dias y los dias correspondientes a los ultimos tercios de estancia. Las causas mas frecuentes de estancias inadecuadas estuvieron relacionadas con el retraso en procedimientos diagnosticos o terapeuticos y con que estos procedimientos podrian haberse hecho sin ingreso.

Introduccion y objetivos La endocarditis derecha aislada es una entidad poco conocida cuando afecta a pacientes no portadores de marcapasos y no adictos a drogas por via parenteral (ADVP). Nuestro objetivo es estudiar la frecuencia actual de esta entidad y describir su perfil clinico, microbiologico, ecocardiografico y pronostico. Metodos Hemos analizado 17 casos de endocarditis derecha aislada en pacientes no ADVP y no portadores de marcapasos, de un total de 583 episodios consecutivamente diagnosticados de endocarditis infecciosa (3%). Resultados La media de edad fue 38 ± 15 anos y 11 pacientes eran varones. El 47% de los pacientes presentaban alguna enfermedad predisponente. El cateter intravascular fue la puerta de entrada mas frecuente (35%). Los sintomas y signos mas comunes al ingreso fueron fiebre, disnea, embolia pulmonar septica, derrame pleural e insuficiencia cardiaca derecha. El microorganismo mas frecuente fue Staphylococcus aureus (41%). La mayoria de los casos asentaron en la valvula tricuspide (82%). La embolia pulmonar recurrente fue la complicacion mas frecuente y la principal causa de cirugia, que fue precisa en 5 (29%) casos. Fallecieron 2 (12%) pacientes, ambos por shock septico. En el seguimiento, 1 paciente fallecio al mes del alta por causa desconocida y 1 presento una recaida al tercer mes. Conclusiones La endocarditis derecha aislada debe incluirse en el diagnostico diferencial de pacientes con sindrome febril, sintomas respiratorios y alguna enfermedad predisponente, aunque no sean portadores de marcapasos o ADVP. La presencia de cateteres intravasculares y la bacteriemia por estafilococos refuerzan la sospecha de endocarditis en estos pacientes.

La tomografia de coherencia optica es una nueva tecnica de diagnostico intracoronario, con una alta resolucion, superior a la de otras tecnicas como la ecografia intravascular. Se estudio mediante tomografia de coherencia optica el resultado tras implantar stent en 6 pacientes sometidos a intervencionismo coronario, con una imagen angiografica normal tras la revascularizacion. Se observo protrusion de material al stent en todos los pacientes, microdisecciones en los bordes del stent en 4 pacientes y mala posicion del stent en 4 pacientes. En 2 pacientes, se observo formacion de pequenos trombos alrededor del cateter de tomografia. La tomografia de coherencia optica permite detectar zonas de resultado suboptimo tras el intervencionismo coronario, a pesar de una adecuada imagen angiografica.

Introduccion y objetivos La cardiorresonancia magnetica con realce tardio de contraste (RMc) permite la deteccion precoz de obstruccion microvascular persistente (OMP) tras un infarto. Hemos analizado el impacto de la OMP en el remodelado ventricular de una cohorte de pacientes con infarto agudo de miocardio con ST elevado (IAMSTE) que recibieron implante intracoronario de celulas mononucleadas de medula osea autologa (CMMOA). Metodos Catorce pacientes recibieron infusion intracoronaria de 66 ± 39 millones de CMMOA a los 8 ± 2 dias de un IAMSTE revascularizado con exito (flujo TIMI 3 epicardico). Se realizaron estudios seriados de RMc con gadolinio-DTPA (basal y a los 10 meses del infarto), con analisis de volumenes y fraccion de eyeccion ventricular izquierda, motilidad regional, tamano del infarto y presencia de OMP (definida como un area con ausencia de senal en el seno del infarto). Resultados Se detecto OMP en 5 (36%) de los 14 pacientes, junto con una tendencia en el estudio basal a presentar un mayor tamano del infarto, mayores volumenes y peor funcion sistolica general y regional de ventriculo izquierdo respecto a aquellos sin OMP. En el seguimiento, la presencia de OMP se relaciono significativamente con un incremento en el volumen telediastolico (25 ± 24 frente a −2 ± 19 ml; p = 0,037), ausencia de incremento en el grosor telediastolico parietal (p = 0,027) y una menor reduccion en el numero de segmentos acineticos o discineticos. Conclusiones La OMP evaluada precozmente mediante RMc tras un IAMSTE revascularizado con exito se asocia con un remodelado ventricular izquierdo adverso en pacientes sometidos a implante intracoronario de CMMOA.

Optical coherence tomography is a new intracoronary diagnostic technique that has a higher resolution than other techniques, such as intravascular ultrasound. We used optical coherence tomography to study outcomes after stent implantation in 6 patients who had undergone percutaneous coronary intervention, and in whom angiography showed normal results after revascularization. Material was observed to protrude through the stent struts in all patients, small dissections were seen at the stent edges in four patients, and there was incomplete stent apposition in 4 patients. In 2 patients, small amounts of thrombus were observed to form around the tomography catheter. With optical coherence tomography, it was possible to detect areas in which the results of percutaneous coronary intervention were suboptimal, despite a satisfactory appearance on angiography.

This study sought to document the safety of a new accelerated dobutamine-atropine stress echocardiography protocol and to analyze its complications.Dobutamine-atropine stress echocardiography studies were performed using an incremental dobutamine infusion protocol from 20 to 40 microg/kg/min in 3-minute stages and followed by atropine.A total of 962 patients were included. Mean age was 64 +/- 11 years and 584 were male (61%). Mean ejection fraction was 62 +/- 10%. Complications included hypertensive responses in 66 patients (7%), arrhythmias in 26 (2.7%), and symptomatic hypotension in 16 (1.7%). No patient developed heart failure, acute myocardial infarction, ventricular fibrillation, or died. The independent predictors of hypertensive responses were age, baseline systolic blood pressure, and treatment with nitrates. The independent predictors of arrhythmias were history of hypertension, previous coronary artery disease, and baseline heart rate.This accelerated dobutamine-atropine stress echocardiography protocol is safe in a low-risk population and has a rate of complications similar to that reported for the standard protocol.

Functional polymorphisms in the genes encoding detoxification enzymes could modify the response to treatment in acute myeloid leukemia and therefore affect the final clinical outcome. In the present study, we genotyped 153 patients diagnosed with de novo acute myeloid leukemia (AML) to clarify the influence of the genetic polymorphisms CYP1A1*2A, CYP3A4*1B, CYP2E1*5B, del{GSTT1}, del{GSTM1}, and NQO1*2 on disease outcome. The del{GSTM1} showed a higher frequency in females (62%) than in males (41%) (P=0.01). The number of functional NQO1 alleles influenced the response to induction therapy; 81% (55/68) NQO1-negative patients, 69% (28/41) heterozygous patients, and 27% (2/7) homozygous patients achieved complete remission (CR) (P=0.04). The presence of GST deletions was associated with a lower probability of disease-free survival (DFS) and this effect was more relevant in male patients. Males with del{GSTM1} showed a 28% DFS versus 57% DFS for undeleted GSTM1 (P=0.04). Similarly, males with undeleted GSTM1 and GSTT1 showed a 64% DFS versus 34% DFS for males with at least one GST deletion (P=0.05). This study suggests that the NQO1*2 polymorphism is relevant to the patient's response to induction therapy and that GST deletions influence treatment outcome after chemotherapy, especially in male patients.

Aims There is no agreement in the best cutoff time to distinguish between early- and late- onset prosthetic valve endocarditis (PVE). Our objectives are to define early-onset PVE according to the microbiological spectrum and to analyse the profile and short-term prognosis of this entity. Methods and results The microbiological profile of 172 non-drug users, who were patients with PVE, were compared according to the time elapsed from surgery among 640 endocarditis diagnosed between 1996 and 2004. There were no differences in the microbiological profile of patients with PVE occurred within 2 months of valve replacement and those accounting between 2 and 12 months. The proportion of coagulase-negative Staphylococci (CNS) was higher during the first year post-intervention (37 vs. 18%, P = 0.005) and Streptococci viridans were more common after 1 year (18 vs. 1%, P = 0.001). The percentage of methicilin-resistant CNS strains was higher before 1 year (77 vs. 30%, P = 0.004). Early-onset PVE represented 38% of all episodes of PVE, CNS being the most frequent isolated microorganisms (37%), most of them methicilin resistant (77%). In-hospital mortality of patients who needed urgent surgery was 46% and elective surgery 25%. Overall, in-hospital mortality was 38% and no differences were seen between surgical and medical groups (32 vs. 45%, P = 0.30). Periannular complications were associated with higher in-hospital mortality (60 vs. 27%, P = 0.007). Conclusion According to the microbiological profile, the most appropriate cutoff time to distinguish between early- and late-onset PVE was 1 year. Methicilin-resistant CNS are the most frequent pathogens and periannular complications, the only risk factor for in-hospital mortality.

Cardiac stem cell therapy with bone-marrow-derived stem cells is a promising approach to facilitate myocardial regeneration after acute myocardial infarction or in congestive heart failure. The clinical data currently available seem to indicate that this approach is safe and is not associated with an increase in the number of adverse clinical events; nevertheless, the level of safety confidence is limited because of the small number of patients who have been treated and the absence of long-term clinical follow-up data. In order to establish the clinical safety of cardiac stem cell therapy, it will be necessary to collect additional data from both previous and ongoing clinical trials in subsets of patients relative to their background risk. Several conceptual safety concerns should also be addressed. These concerns relate to a number of operational mechanisms and include biological effects on differentiation, remote homing of transplanted stem cells, progression of atherosclerosis, and arrhythmias. The proactive scrutiny of these phenomena could eventually facilitate the translation of the promise of cardiac regeneration into a safe and effective therapy.

Introduccion y objetivos Describir las caracteristicas epidemiologicas, clinicas, microbiologicas, ecocardiograficas y evolutivas de los pacientes con un sindrome coronario agudo en el seno de una endocarditis. Metodos Hemos analizado 586 episodios de endocarditis (481 izquierdos) diagnosticados de forma consecutiva en 5 hospitales desde 1995 hasta 2005. Resultados Hubo 14 pacientes (2,9%) con un sindrome coronario agudo, con una edad media de 50 ± 17 anos. El 50% tenian una protesis valvular. Los cultivos fueron positivos en 11 episodios y el germen aislado con mas frecuencia fue Staphylococcus aureus. La ecocardiografia transesofagica detecto vegetaciones en 12 casos. La localizacion de la infeccion fue aortica en 12 casos. Se documentaron con mas frecuencia complicaciones perivalvulares (n = 11 [78,6%] frente a n = 172 [36,8%]; p = 0,03) y su tamano fue mayor que el de los otros pacientes de la serie. Trece pacientes tuvieron insuficiencia valvular de moderada a severa. El sindrome coronario agudo se manifesto precozmente en la mayoria de los pacientes. El mecanismo de la isquemia fue embolico en 3 casos y por compresion coronaria en 8. Durante la evolucion, los pacientes con sindrome coronario agudo tuvieron una mayor incidencia de insuficiencia cardiaca (n = 6 [42,85%] frente a n = 77 [16,48%]; p = 0,021), shock cardiogenico (n = 5 [35,7%] frente a n = 71 [15,2%]; p = 0,038) y bloqueo auriculoventricular (n = 4 [28,57%] frente a 43 [9,2%]; p = 0,039). La mortalidad fue tambien superior en estos pacientes (n = 9 [64,29%] frente a n = 151 [32,33%]; p = 0,019). Conclusiones El sindrome coronario agudo es una complicacion precoz de la endocarditis. Se asocia mas a microorganismos virulentos, infeccion valvular aortica, insuficiencia valvular severa, complicaciones perianulares de gran tamano y elevada mortalidad. El mecanismo mas frecuente fue la compresion coronaria secundaria a complicaciones perianulares.

Infective endocarditis (IE) due to Streptococcus bovis has been classically associated with elderly patients, frequently involving1 valve, with large vegetations and high embolic risk, which make it a high-risk group. Our aim is to analyze the current clinical profile and prognosis of S bovis IE episodes, in comparison to those episodes caused by viridans group streptococci and enterococci.We analyzed 1242 consecutive episodes of IE prospectively recruited on an ongoing multipurpose database, of which 294 were streptococcal left-sided IE and comprised our study group. They were classified into 3 groups: group I (n = 47), episodes of IE due to S bovis; group II (n = 134), episodes due to viridans group streptococci; and group III (n = 113), those episodes due to enterococci.The incidence of enterococci IE has significantly increased in the last 2 decades (6.4% [1996-2004] vs 11.1% [2005-2013]; P = .005), whereas the incidence of IE due to S bovis and viridans streptococci have remained stable (4% and 10%, respectively). Gender distribution was similar in the 3 groups. Patients with S bovis and enterococci IE were older than those from group II. Nosocomial acquisition was more frequent in group III. Concerning comorbidity, diabetes mellitus (36.7% vs 9.2% vs 26.8%; P.001) was more common in groups I and III. Chronic renal failure was more prevalent in patients from group III (4.2% vs 1.5% vs 19%; P.001). Prosthetic valve IE was more frequent in enterococcal IE. Infection upon normal native valves was more frequent in S bovis IE. Colorectal tumors were found in 69% of patients from this group. Vegetation detection was similar in the 3 groups. However, vegetation size was smaller in S bovis IE. During hospitalization, in-hospital complications and in-hospital mortality were higher in enterococci episodes.S bovis IE accounts for 3.8% of all IE episodes in our cohort; it is associated with a high prevalence of colonic tumors, with predominance of benign lesions, and affects patients without preexisting valve disease. It is related to small vegetations and a low rate of in-hospital complications, including systemic embolisms. In-hospital mortality is similar to that of viridans group streptococci.

To describe the profile of left-sided polymicrobial endocarditis (PE) and to compare it with monomicrobial endocarditis (ME). Among 1011 episodes of left-sided endocarditis consecutively diagnosed in 3 tertiary centers, between January 1, 1996 and December 31, 2014, 60 were polymicrobial (5.9%), 821 monomicrobial (81.7%), and in 123 no microorganism was detected (12.2%). Seven patients (0.7%) were excluded from the analysis because contamination of biologic tissue could not be discarded. The authors described the clinical, microbiologic, echocardiographic, and outcome of patients with PE and compared it with ME. Mean age was 64 years SD 16 years, 67% were men and 30% nosocomial. Diabetes mellitus (35%) were the most frequent comorbidities, fever (67%) and heart failure (43%) the most common symptoms at admission. Prosthetic valves (50%) were the most frequent infection location and coagulase-negative Staphylococci (48%) and enterococci (37%) the leading etiologies. The most repeated combination was coagulase-negative Staphylococci with enterococci (n = 9). Polymicrobial endocarditis appeared more frequently in patients with underlying disease (70% versus 56%, P = 0.036), mostly diabetics (35% versus 24%, P = 0.044) with previous cardiac surgery (15% versus 8% P = 0.049) and prosthetic valves (50% versus 37%, P = 0.038). Coagulase-negative Staphylococci, enterococci, Gram-negative bacilli, anaerobes, and fungi were more frequent in PE. No differences on age, sex, symptoms, need of surgery, and in-hospital mortality were detected. Polymicrobial endocarditis represents 5.9% of episodes of left-sided endocarditis in our series. Despite relevant demographic and microbiologic differences between PE and ME, short-term outcome is similar.

et al., Different types and routes of stem cell delivery have been used in clinical practice to repair infarcted or ischaemic myocardium. Of these, percutaneous administration of bone-marrow-derived progenitors represents the most optimal method to date, as it allows the evaluation of the cells' effects independent of revascularization and the application of multiple administrations over time. Two different percutaneous catheter-based methods have been used in clinical trials to deliver bone-marrow-derived stem cells: intracoronary infusion and transendomyocardial delivery through a left ventricle catheter. Despite the clinical scenarios investigated (acute myocardial infarction, chronic ischaemia with no revascularization option, and ischaemic cardiomyopathy), in general percutaneous bone-marrow-derived stem cell therapy is feasible, relatively safe (with unresolved concerns regarding arrhythmias, restenosis, and atherosclerosis progresion), and could exert a benefit upon ventricular function and perfusion. At this point, intermediate-size, randomized trials are aimed to well establish the efficacy of this therapy that analyses surrogate endpoints: either perfusion or left ventricular function based on the clinical scenario tested. © The European Society of Cardiology 2006. All rights reserved.

The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p0.001), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 172 patients (86%), and in-hospital mortality in the overall population was 29%. Multivariate analysis identified age60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality.

Fundamento y objetivo: La enfermedad de Behcet (EB) es una entidad clinica poco prevalente en Espana. Son escasos los articulos publicados sobre datos epidemiologicos y manifestaciones clinicas en nuestro pais. El objetivo del presente estudio ha sido conocer las caracteristicas de las manifestaciones clinicas de la EB en la Comunidad Valenciana. Pacientes y metodo: Se recogieron datos de los pacientes diagnosticados entre 1990 y 2005 de EB en los Hospitales Universitarios La Fe, General y Doctor Peset de Valencia. Todos los pacientes cumplian los criterios diagnosticos del Grupo de Estudio Internacional para el diagnostico de la EB. Las diferencias entre sexos se analizaron mediante el test de la *2. Resultados: Formaron el grupo de estudio 74 pacientes (40 varones y 34 mujeres). Las manifestaciones clinicas mas frecuentes fueron las aftas orales (98,5%) y genitales (82,4%), seguidas de las cutaneas (64,2%), oculares (42,5%), fiebre (39,4%) y vasculares (28,4%), con predominio de las trombosis venosas sobre las arteriales. Solo las manifestaciones gastrointestinales fueron mas frecuentes en el sexo femenino (p = 0,002). Las alteraciones vasculares y oculares fueron mas graves en los varones. En cuanto a la prevalencia de los factores de riesgo cardiovascular, el 32,4% de los pacientes eran fumadores, un 20,3% presentaba hiperlipemia; un 19%, hipertension; un 13,5%, obesidad, y un 9,5%, diabetes, aunque no se observo asociacion entre estos y los episodios tromboticos ni la uveitis posterior (p > 0,05). Conclusiones: Los resultados obtenidos fueron similares a los de otras areas geograficas. Destacan la mayor frecuencia de manifestaciones digestivas en mujeres y el predominio de los episodios tromboticos venosos sobre los arteriales. Los factores de riesgo cardiovascular no parecen desempenar un papel en el desarrollo de episodios tromboticos ni uveitis posterior en estos pacientes.

Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality. Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis. Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.

La resonancia magnetica es ya una tecnica diagnostica utilizada de forma sistematica por los cardiologos. Su demostrada utilidad y superioridad frente a otras tecnicas de imagen en el estudio de la cardiopatia isquemica es, muy probablemente, la causa del gran interes que ha despertado en los ultimos anos. La cuantificacion de la funcion ventricular global y segmentaria, de la perfusion miocardica y de la viabilidad ha hecho que con una sola tecnica pueda valorarse de forma completa al paciente con cardiopatia isquemica. Sin embargo, muchos aspectos basicos de la resonancia magnetica siguen siendo desconocidos para una amplia mayoria. En este trabajo exponemos sus fundamentos, componentes del equipo, distintas secuencias, utilizacion de contrastes, seguridad y contraindicaciones.

From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the “3 noes” endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted. Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 “3 noes” group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The “3 noes” endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the “3 noes” group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the “3 noes”, P

Los estafilococos coagulasa negativos (SCN) son los microorganismos aislados con mas frecuencia en la endocarditis protesica temprana. En cambio, afectan en pocas ocasiones a las valvulas nativas. Hay escasos y antiguos datos en la bibliografia sobre la endocarditis nativa izquierda por SCN, por lo que su perfil es poco conocido. Hemos analizado las caracteristicas epidemiologicas, clinicas, radiologicas, microbiologicas, ecocardiograficas y evolutivas de 17 casos de endocarditis izquierda nativa por SCN obtenidas de una serie de 441 episodios consecutivos de endocarditis. Los resultados muestran un aumento en la frecuencia de esta enfermedad respecto de las series previas. Clinicamente provocan en numerosas ocasiones insuficiencia cardiaca por afeccion valvular, precisan con frecuencia cirugia y tienen una alta mortalidad.

Coagulase-negative staphylococci are the most frequently isolated microorganisms in early prosthetic valve endocarditis. However, they rarely cause endocarditis in native valves. The profile of patients with left-sided native valve endocarditis by coagulase-negative staphylococci is unknown, because available data are scarce and outdated. We analyzed the epidemiological, clinical, radio-graphic, microbiological, and echocardiographic features and clinical course in 17 patients with this entity out of a total of 441 consecutive patients diagnosed as having endocarditis. The results show that left-sided native valve endocarditis caused by coagulase-negative staphylococci is more common than previously reported, can cause heart failure due to valvular involvement, often needs surgery, and is associated with high mortality.

Introduction and objectives Published case series on Streptococcus viridans endocarditis are scarce and outdated. The aims of our study were multiple: to analyze the profile of the Streptococcus viridans endocarditis, to compare it with other types of left-sided endocarditis and with cases caused by Staphylococcus aureus, and to determine predictors of poor outcome in Streptococcus viridans endocarditis. Patients and method We analyzed 441 episodes of endocarditis: 330 left-sided and 54 caused by Streptococcus viridans (16%). We compared the 54 cases due to Streptococcus viridans with the remaining cases of left-sided endocarditis in our series, and also with cases caused by Staphylococcus aureus. We also analyzed the predictors of death and urgent surgery in Streptococcus viridans endocarditis. Results Left-sided endocarditis due to Streptococcus viridans led to a similar degree of valvular destruction, showed acute onset less frequently, and led to less renal failure, septic shock and mortality than the remaining cases of left-sided endocarditis in our series. The same differences were found in comparison to Staphylococcus aureus endocarditis. Prognostic factors for Streptococcus viridans left-sided endocarditis were heart failure and periannular complications. Conclusions Although Streptococcus viridans is a no-naggressive microorganism, valvular destruction is similar to that caused by other pathogens when it causes left-sided endocarditis. Nonetheless its prognosis is better, a feature which may be related to the fact that the systemic infectious syndrome can be treated more effectively. Prognostic factors in left-sided endocarditis due to Streptococcus viridans are heart failure and periannular complications. Introduccion y objetivos Hay escasas y antiguas series en la literatura medica respecto de la endocarditis por Streptococcus viridans. Nuestro objetivo ha sido multiple: analizar el perfil de la endocarditis por Streptococcus viridans, compararlo con el resto de las endocarditis izquierdas y con la endocarditis por Staphylococcus aureus y determinar los factores predictores de mal pronostico en la endocarditis por Streptococcus viridans. Pacientes y metodo Hemos analizado 441 episodios de endocarditis: 330 izquierdas y 54 (16%) provocados por Streptococcus viridans. Hemos comparado las 54 endocarditis por Streptococcus viridans con las provocadas por el resto de las endocarditis izquierdas de nuestra se-rie y en un segundo analisis con las provocadas por Staphylococcus aureus. Tambien hemos realizado un analisis de los factores predictores de muerte o cirugia urgente en la endocarditis por Streptococcus viridans. Resultados Las endocarditis izquierdas por Streptococcus viridans provocan una destruccion valvular similar, tienen menos frecuentemente un curso agudo, provocan menos insuficiencia renal, shock septico y menor mortali-dad que el resto de las endocarditis izquierdas de nuestra serie. Al compararlas con las endocarditis por Staphylococcus aureus se encontraron las mismas diferencias. Los factores determinantes del pronostico en la endocarditis izquierda por Streptococcus viridans fueron la insuficiencia cardiaca y las complicaciones perianulares. Conclusiones Aunque Streptococcus viridans es un microorganismo poco agresivo, cuando provoca endocarditis izquierda da lugar a una destruccion valvular semejante a la del resto de las endocarditis. Sin embargo, el pronostico es mas favorable, lo que podria estar en relacion con el hecho de que el sindrome infeccioso general se controla mejor. Los factores que determinan su pronostico son la insuficiencia cardiaca y las complicaciones perianulares.

Introduccion y objetivos Hay escasas y antiguas series en la literatura medica respecto de la endocarditis por Streptococcus viridans . Nuestro objetivo ha sido multiple: analizar el perfil de la endocarditis por Streptococcus viridans , compararlo con el resto de las endocarditis izquierdas y con la endocarditis por Staphylococcus aureus y determinar los factores predictores de mal pronostico en la endocarditis por Streptococcus viridans . Pacientes y metodo Hemos analizado 441 episodios de endocarditis: 330 izquierdas y 54 (16%) provocados por Streptococcus viridans . Hemos comparado las 54 endocarditis por Streptococcus viridans con las provocadas por el resto de las endocarditis izquierdas de nuestra serie y en un segundo analisis con las provocadas por Staphylococcus aureus . Tambien hemos realizado un analisis de los factores predictores de muerte o cirugia urgente en la endocarditis por Streptococcus viridans. Resultados Las endocarditis izquierdas por Streptococcus viridans provocan una destruccion valvular similar, tienen menos frecuentemente un curso agudo, provocan menos insuficiencia renal, shock septico y menor mortalidad que el resto de las endocarditis izquierdas de nuestra serie. Al compararlas con las endocarditis por Staphylococcus aureus se encontraron las mismas diferencias. Los factores determinantes del pronostico en la endocarditis izquierda por Streptococcus viridans fueron la insuficiencia cardiaca y las complicaciones perianulares. Conclusiones Aunque Streptococcus viridans es un microorganismo poco agresivo, cuando provoca endocarditis izquierda da lugar a una destruccion valvular semejante a la del resto de las endocarditis. Sin embargo, el pronostico es mas favorable, lo que podria estar en relacion con el hecho de que el sindrome infeccioso general se controla mejor. Los factores que determinan su pronostico son la insuficiencia cardiaca y las complicaciones perianulares.

Introduccion y objetivos Dentro de las complicaciones de la endocarditis infecciosa, la embolia sistematica constituye un evento ominoso respecto al pronostico final. El objetivo de este estudio es analizar las caracteristicas demograficas, clinicas y microbiologicas de los episodios de endocarditis que cursan con embolias en el bazo, el higado o el rinon y compararlas con los que no las presentan. Tambien se ha querido conocer el impacto pronostico de estas embolias. Material y metodo Estudio de cohorte clinica prospectivo, multicentrico. Se han analizado 338 episodios consecutivos de endocarditis izquierda en 308 pacientes, clasificados en 2 grupos: grupo I, episodios con embolias hepatoesplenorrenales (n = 34); y grupo II, episodios sin estas embolias (n = 304). Resultados Se documentaron 41 embolias en 34 episodios (10%): 34 embolias en el bazo, 5 en el rinon y 2 en el higado. Ciertas formas de presentacion clinica fueron mas frecuentes en el grupo I: dolor abdominal, esplenomegalia, hematuria, manifestaciones cutaneas, embolia en otras localizaciones y shock septico. Staphylococcus aureus y enterococos se aislaron con mas frecuencia en el grupo I que en el grupo II. La deteccion de vegetaciones mediante ecocardiograma transesofagico fue mas frecuente en el grupo I, y tenian un tamano mayor. La presencia de embolias hepatoesplenorrenales no se asocio de forma independiente a la necesidad de cirugia ni al riesgo de mortalidad. Conclusiones Las embolias hepatoesplenorrenales aparecen en un 10% de los episodios de endocarditis izquierda, con una forma de presentacion clinica caracteristica. Las vegetaciones en estos episodios son de mayor tamano que en los demas. Su presencia no incrementa la necesidad de cirugia ni el riesgo de muerte.

Aims To investigate the clinical features, echocardiographic characteristics, management, and prognostic factors of mortality of aorto-cavitary fistulization (ACF) in infective endocarditis (IE). Extension of infection in aortic valve IE beyond valvular structures may result in peri-annular complications with resulting necrosis and rupture, and subsequent development of ACF. Aorto-cavitary communications create intra-cardiac shunts, which may result in further clinical deterioration and haemodynamic instability. Methods and results In a retrospective multi-centre study over 4681 episodes of IE, a total of 76 patients with ACF [1.6%, confidence interval (CI) 95%: 1.2–2.0%] diagnosed by echocardiography or during surgery were identified. Fistulae were found in 1.8% of cases of native valve IE and in 3.5% of cases of prosthetic valve IE from the general population and in 0.4% of drug abusers. PVE was present in 31 (41%) cases of ACF. Transthoracic and transoesophageal echocardiography detected the fistulous tracts in 53 and 97% of cases, respectively. Peri-annular abscesses were detected in 78% of cases, fistulae originated in similar rates from the three sinuses of Valsalva, and the four cardiac chambers were equally involved in the fistulous tracts. Heart failure (HF) developed in 62% of cases and surgery was performed in 66 (87% CI 95% 77–93%) patients with a mortality of 41% (95% CI 30–53%) in the overall population. Multivariate analysis identified HF (OR 3.4, CI 95% 1.0–11.5), prosthetic IE (OR 4.6, CI 95% 1.4–15.4) and urgent or emergency surgical treatment (OR 4.3, CI 95% 1.3–16.6) as variables significantly associated with an increased risk of death. Major complications during follow-up (death, re-operation, or re-admission for HF) among the five operative survivors with residual fistulae occurred in 20 and 100% of patients at 1 and 2 years, respectively. Conclusion Aorto-cavitary fistulous tract formation is an uncommon but extremely serious complication of IE. In-hospital mortality was exceptionally high despite aggressive management with surgical intervention in the majority of patients. Prosthetic IE, urgent surgery, and the development of HF identify the subgroup of patients with IE and ACF that have significantly increased risk of in-hospital death.

In patients with ST-segment elevated myocardial infarction (STEMI), early post-thrombolysis routine angioplasty has been discouraged because of its association with high incidence of events. The GRACIA-1 trial was designed to reassess the benefits of an early post-thrombolysis interventional approach in the era of stents and new antiplatelet agents.500 patients with thrombolysed STEMI (with recombinant tissue plasminogen activator) were randomly assigned to angiography and intervention if indicated within 24 h of thrombolysis, or to an ischaemia-guided conservative approach. The primary endpoint was the combined rate of death, reinfarction, or revascularisation at 12 months. Analysis was by intention to treat.Invasive treatment included stenting of the culprit artery in 80% (199 of 248) patients, bypass surgery in six (2%), non-culprit artery stenting in three, and no intervention in 40 (16%). Predischarge revascularisation was needed in 51 of 252 patients in the conservative group. By comparison with patients receiving conservative treatment, by 1 year, patients in the invasive group had lower frequency of primary endpoint (23 [9%] vs 51 [21%], risk ratio 0.44 [95% CI 0.28-0.70], p=0.0008), and they tended to have reduced rate of death or reinfarction (7% vs 12%, 0.59 [0.33-1.05], p=0.07). Index time in hospital was shorter in the invasive group, with no differences in major bleeding or vascular complications. At 30 days both groups had a similar incidence of cardiac events. In-hospital incidence of revascularisation induced by spontaneous recurrence of ischaemia was higher in patients in the conservative group than in those in the invasive group.In patients with STEMI, early post-thrombolysis catheterisation and appropriate intervention is safe and might be preferable to a conservative strategy since it reduces the need for unplanned in-hospital revascularisation, and improves 1-year clinical outcome.

Introduccion y objetivos Trabajos experimentales y clinicos sugieren que el tejido necrotico tiene la capacidad de regenerarse. Nuestro grupo ha comenzado un estudio clinico para demostrar que la implantacion intracoronaria de celulas madre es un procedimiento factible y seguro. Presentamos los resultados de nuestros primeros 5 pacientes. Pacientes y metodo Se ha incluido a pacientes con un infarto agudo de miocardio anterior y una lesion unica en la descendente anterior reparada mediante angioplastia primaria o facilitada. A los 10-15 dias del infarto, se procedio a la extraccion de medula osea. El implante celular se hizo por via intracoronaria. El protocolo de seguimiento incluye ecocardiografia con dobutamina, resonancia magnetica y Holter de ECG basal y a los 6 meses. Resultados Ningun paciente ha tenido un evento cardiaco tras 6 meses de seguimiento. En un paciente se observo un accidente isquemico transitorio sin secuelas. No se han demostrado arritmias en ninguno de los pacientes. El volumen telediastolico no vario a los 6 meses (159 ± 25 y 157 ± 16 ml), el volumen telesistolico disminuyo (77 ± 22 y 65 ± 16 ml) y la fraccion de eyeccion aumento (53 ± 7 y 58 ± 8%), aunque no hubo diferencias significativas. En los 3 pacientes en los que la ecocardiografia con dobutamina descarto viabilidad, si hubo una disminucion significativa de los volumenes. Conclusiones El implante intracoronario de celulas madre en pacientes que han tenido un infarto agudo de miocardio parece un metodo seguro y factible, y podria dar lugar a un remodelado favorable.

Background Streptococcus agalactiae is an unusual pathogen in adults who are not pregnant. S agalactiae endocarditis is a poorly defined entity because it is uncommon; in contrast to other streptococcal endocarditis, it bears a high mortality rate. The aim of this study was to define its clinical, prognostic, and therapeutic profile on the basis of a series of 9 consecutive patients. Methods We conducted a prospective and multicenter study of patients with infectious endocarditis in which 310 episodes were included. Results S agalactiae grew in 9 patients (3%) who had no valve prosthesis. All patients except 1 had underlying diseases, and all patients had serious complications; the most common complications were major emboli, heart failure, and shock. The valve affected was the mitral valve in 4 patients, the aortic valve in 2 patients, both the mitral and aortic valves in 2 patients, and the tricuspid valve in 1 patient. All episodes were on native valves. Vegetations tended to be large (maximal diameter >10 mm in all patients), very mobile, and pedunculated. An abscess was found in 2 patients, and a perforation of the valve developed in 3 patients. Five patients died (mortality rate, 56%), 3 of whom had received antibiotic therapy alone. The 4 patients who survived underwent combined medical-surgical therapy. Conclusion S agalactiae native valve endocarditis is very aggressive, and early surgery should be considered to prevent the destruction of valves and development of serious complications.

All- trans -retinoic acid (ATRA) increases the efficacy of chemotherapy when used for induction and maintenance treatment of acute promyelocytic leukemia (APL), but its role in consolidation is unknown. Since November 1996, 426 patients with newly diagnosed APL have received induction therapy with ATRA and idarubicin. Before November 1999 (LPA96 study), consolidation therapy consisted of 3 courses of anthracycline monochemotherapy. After November 1999 (LPA99 study), patients with intermediate and high risks of relapse received consolidation therapy with ATRA and increased doses of anthracyclines. Of the 384 patients who achieved complete remission (90%), 382 proceeded to consolidation therapy. Seven patients died in remission (1.8%). The 3-year cumulative incidence of relapse for patients in the LPA96 and LPA99 studies was 17.2% and 7.5%, respectively ( P = .008). Patients treated with ATRA in consolidation therapy showed an overall reduction in the relapse rate from 20.1% to 8.7% ( P = .004). In intermediate-risk patients the rate decreased from 14.0% to 2.5% ( P = .006). This improved antileukemic efficacy also translated into significantly better disease-free and overall survival. A risk-adapted strategy combining anthracycline monochemotherapy and ATRA for induction and consolidation therapy of newly diagnosed APL results in improved antileukemic efficacy and a high degree of compliance.